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Aetcom and role of surgeons

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AETCOM role of surgeon MBBS curriculum

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https://cbmesurgery.com/aetcom-in-surgery

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AETCOM and the Role of Surgeons

What AETCOM is
AETCOM (Attitude, Ethics, and Communication) is a competency module introduced by the Medical Council of India (now NMC) into the Competency-Based Medical Education (CBME) curriculum in 2019. It runs as a longitudinal thread across all four years of the MBBS course (27 modules total) and is meant to complement clinical/technical training with the "soft skill" competencies of medicine - how a doctor relates to patients, families, colleagues, and society. It was created because older curricula focused almost entirely on disease knowledge and procedural skill, leaving communication, ethical reasoning, and professional attitude largely untaught and only picked up informally ("hidden curriculum").
AETCOM rests on three pillars:
  1. Attitude - empathy, respect, non-judgmental conduct, cultural sensitivity, humility.
  2. Ethics - informed consent, confidentiality, truth-telling, resource allocation, professional integrity, medico-legal responsibility.
  3. Communication - breaking bad news, shared decision-making, handling difficult conversations with patients/families, inter-professional communication with the surgical/healthcare team.
Why it matters specifically for surgeons
Surgery has unique stakes that make AETCOM more than an academic add-on:
  • Informed consent for an invasive, risk-bearing intervention requires the surgeon to communicate risks, benefits, and alternatives clearly and check real understanding, not just obtain a signature.
  • Preoperative anxiety and trust directly affect outcomes; surgeons who communicate well reduce patient anxiety and improve compliance with perioperative instructions.
  • Breaking bad news is routine in surgical practice (unexpected malignancy on biopsy, intraoperative findings, complications) and requires structured approaches such as the SPIKES/SPICES model for staged, honest, compassionate disclosure.
  • Ethical dilemmas are common - patients who cannot afford recommended surgery, family requests to withhold a cancer diagnosis, conflicts between patient autonomy and family/cultural preference (e.g., preference for a particular surgeon's gender), or resource-limited settings where the surgeon must balance urgency against availability (e.g., linking patients to social workers or government health schemes).
  • Multidisciplinary teamwork - a surgeon must communicate effectively with anesthesiologists, nursing staff, oncology teams, and referring physicians; this affects patient safety directly.
Role of the surgeon (broader professionalism framework)
Surgical textbooks frame the surgeon's professional role through three complementary models (as described in Sabiston's Textbook of Surgery, p. professionalism chapter):
  1. Virtue-based professionalism - cultivating an inner disposition of compassion, empathy, humility, and service, so that ethical behavior becomes habitual rather than deliberated under time pressure (critical in the operating room, where "time and space constraints preclude deliberative moral reasoning").
  2. Behavior-based professionalism - external standards, feedback, and accountability structures that reinforce desired conduct (consent practices, disclosure protocols, documentation standards).
  3. Professional identity formation - the surgeon's professional self develops through social and relational context, role models, and the "hidden curriculum" of the training environment, not just formal teaching.
"Taken together, these frameworks provide a rich matrix through which to view an individual surgeon's lifelong professional journey." - Sabiston Textbook of Surgery
In addition to clinical/technical duties, the surgeon's professional role includes being a team leader (coordinating, directing, and supervising the surgical and ward team), an educator (training juniors, nurses, and paramedical staff), a communicator/counselor (with patients and families before and after operations), and an ethical agent who safeguards patient autonomy, confidentiality, and equitable care even under resource or cultural pressure.
Practical takeaway for MBBS/surgical trainees: AETCOM is assessed through OSCE-style stations, role-plays, and reflective portfolios during clinical postings, and increasingly examiners expect students to demonstrate consent-taking, breaking-bad-news scenarios, and ethical case discussions as part of surgery postings - not just operative knowledge.
If you want, I can pull the specific AETCOM Module numbers/competencies mapped to the Surgery posting (as per the NMC AETCOM manual) or go deeper into a specific scenario (e.g., surgical consent, disclosure of intraoperative complications).
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